Loading...
A28 49� ,- <, '= -� . . � The-�Distr�ct �' �th<._Depar�men# , ,: �, Ozange.-.Persoa....Caswell._`.�halhaas;: Lee._.Counties �: , , _ , ��� W4ter-Sup � lyi and �Sewage;�Dis osal �. ;s __ _ , , P , � r ; � . ,c � -`IMFRO�NTS FEAMIT . No . . . � ��a , � :�a�—=�' � Datp � J - ? �7 il� : ... ---••- ,.___.-;, ,_...,..r. �._c.��_ ;.. .__ ,: �. � �amer " ,.in� � , ��� . y;�� 'Tf".�e.��wl�. �: _�, ' pq,, Location . i ;} Y.L' . ' r � - , . _ � �_1 �' �l. -- , _.. . _ � ._ _.. -: �. €: ; ; , � �'� " _ _ ____. . wP'i"` , _ , . �p; Contractor ` ,�:_ . . _. . ,__ _. .- •- • �-_ . ,. ,:. :. _ _.__.. �r �_ - r_.._. . _ ; . �: Wates Supplp: Pnvate blic .: ^� �� Sewage iDi'sposel-Faciliiies: -No.-bedrooms- Dishwashex�.-Disposal, „ . r. =�,.-.---,.._.._.... .; ...... �araslung machin other auto�atic appliances E _. _ _ _ , ._ . _. _, Size;•of tank ` r ' �`; �• Nitriflcation line. _ .��f{� `� � � �' /_� �. % -_. _/:!' �_ � . ..: __1 , r, v�ner wsppsai zaeiutiy-�•�-�;: �•<.• ., xrr a.r >.. . r�--r ;;, . - . � J.. Water supply`• siid� sewage d.isp'osal facilities location, u •� protection must meet atate , and local regulations. � 5eptic tank�should.be� puiriped out every,3 fo' 5 years andi tained by owner m such;a manner as not to create, a�. pub�lic ' Septic tank"and""riitriflcahon`� li2ie "NiUST BE"INSPECT � PR,OVEI3 BY A` MEMBER, OF THE DISTRICT I�EAI,TH -i � STAFE:�BEFORE ANY'.PQR.si'ION"OF:TIiE-•INSTAIjI:A7 ' EFtED ANt� FUT I . NTQ USE. _: � � .. ' . .. . .. ,• ; _ . . `,. f,. T _. � r '� � ` � ` � �,j� �,�a�- I-•I- ...__ .. , Y" '9i�i,�w�•�: i a5 Date approved• : _ _._ _ Slgn� ., '• a . t ..►SAYll •, 't8T18T1 ' a Well: _... _ _. ..- - - - -- , - . . . . . __,_.._ __ . .,_.__... zi� N : :', S�ewage Disposal•� _. .. . ._ .__ ..,... .,.. _ _ _: _. _ :--- CO13I1tET _.. - _.__.. . . Bi��j; ; i � j � `• By� ' ' (Owner-ori his-iepresentative) . ; : , , ' I .�",�., ' : � ' ' ' . . . ' j 1 . ` ' ' .... ._ . . :.. ... : . .. . ' ' . . ._.. : � ! : ... . . s- . � . . .` . ... ._. � . .. . ..;.... .. .. . _:_._ ...... .. . . .... .. .. . � CertiScate� o� Compl�et�o� . � ' ;, } �,,... . ' . . I..� . -._ /� . . . . ... . . ,� ,: _.. . . . Date Appio �$` i �v` _ � g ' � ,i ' � _ _ Sanitanan� . _. ..._ ... .. ..«. 1 . �. i. ; . l } , '._. ..:. _. . . .... .__.. ' �0'Y•L'R� . . . . . Location of we1T and sewage disposal facilities sketched on back. ^ ,.�.�`•;r Y y � � 3 � 0 v � '5 '� a � � �. �o � � � � Y y N ..�. � i� � y Y � v o ° � � y �� � v �� � � I�' � � ' .i �� � � � .s . o ° , �o 0 3 � � y �n a � .V 0 � -.G �s i � � � U x N x � Ei O z �- `i 02/09/2001 16:05 FtLY �365992159 ,�, ..-1�i,,, .; . . � �� :,t . . �L �� r �� � -- �_, •. : James tP Short l�ooi Tssc 11�Q . _ ��� ��,� � 9 p� n Couniv H�i� ��srtm�i! _..���---. -. - - ,� �; � �� �►�t Pe�m;�-� - � . ��•�, ..• : : Ja � �� 1y Pernrn�►iit �sqtwR�d Ncme Phone: �; 6ust�es P�,one:: � � . - . .� � , � � E:��'.�L7.�' '' ` � �. -- �-rr:►. . • .a . . - �l [�Ean� Md s�ddt�.t otwes�Rt owno� � �''�tt� r� -� q�r�..4 COrl-�l-uC�t�°� l 3� Propi�lY dModptlan: �ae al:a: d• ����-T�s _..,�,.— •`� � i� � � 0.� 0 C�t�- Q Ot..- ��.{ �J Oit�ona to U►e � fnc�ng to�d namas enc! numba�s} _` r�" �" � ,t_. ' a.v�a � S� }.� p�$ �o : .� �-er' C'_ �r- o_ �� "' b j" p r' '�/ � a� P�apo�d ws arui s�rs�"u�ptlon: an�►aer ead+ ot f� ibtlowk� questians: 2 5-�a ��''� a) Propoeed oe 6�thg �il% b) stt�c 6u9t �GAodutat i�e YVtde D. Dot�bb Wfds 0 c? NumOer ct BeQroort�a:C�� � t�iumber ot oauP�fb�► or peapb ta be aerved: e) sasemer� Ye�+o. Wo nres.�� o�ae��4u��;,__ ' t} GarbaBa Oiapoad: Yes O. No 9) Dknsttsicns oi Propoaed 3f:uc�e: VYldth: _,_,,, Dept� s} YYater suppiy Type: P�a 0(e�ew 0 or�e�darinng 0� Pubitc 4 Ccn�ra�lY fl. SP�B d Ma erry waUs at ac�oW� WnP� Ye� 0 P10 Q tf yes, loealfo�t�� S} Pleas IndlcaW Des�.d Systsm i yPe� ts�sb�s r�n b. ranlo�d In orOvr of yo�a pt�fec+e�ttr.e) / _�CanveMlaW MoaiPi�tt Coe�wrWonql _At�rta�r� ....�rnt+�►�qw O!l+�r (�Paai!!►): ��_._ -- CLEARLY S'�AKE AL�. GORNBRB AND �S OF THE PR�AER77. STAKE 7ME GORNERS O� Ai,1 PROPQB�D 5TR11C711RE'8. pt,EASE ATfARH SUFtVEY PLAT OR 8iiE PLAN TO 't�8 APP1.tCA'�1aN �t +-+. � f-�o� S �,,, 1 1�ersby mske app8c�ttcn to tbe Perso� County H� � to� a 8� eyap�fa�a1 tor tha er�-she eeiwage dispoaai system for �e 3boV�dASC�� ProPenY• 1 agree tlsat Ett�e cxr�ttts of th{r eppHcetlon SC+B Vi1e imd ropresent the tt�dmtan f�l"ilies t0 be placed on lile P�R�Y- 1 vtber3ias�d if the �te b aimted or ttse Itrtanded ttm ch�, th9 p�xtNt Ntall beoom� lr�vaAd. t underatand that ea ap�ir�nt. 1 am nssponeible fa id�t�jrin9 and marfdn0 Pc�CtY !lnes. cnmat� and makin4 ttu� aita aca.ssibla for ttna p of �►a Persoo Cawny �epsirbn�rrt tn conduct th� ev�ona. I� 1ltat I am n�sponstb�a tor notifyinQ @+e N¢etth et4nent if mY Prop weGsrt� a� � bY �%�+'rtN �4s � 1� - o� 2 � -� or l.og�! RiDpcgset►t�iive Date ' PGND, tav. t01121� t0 �d 9iVINOZ QNt!' 9NINtW�d 66Li165 SE�ZT 'i88Z/60/Z0 Tax Map Jl: f7�a O Parr.e! #�_ Apw�� � f,t.e P a I(YIt�O n,e,N j 1 Locadon: ��. I e G1C � l vtn � PIN subdivision PhaselSectfon lottF � ��r Imc�rovement P�rmit New Addition Type of Structure _ Water Suppiy . # of Occupants # of Bedrooms Other System Type Projected Daily �low: g.p.d. Permit Valid For. ❑ Five Years �] No Expiration Proposed Wastewater System: Proposed Repair. � Date: The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate goveming bodies in meeting their requirements. This site is subject to revocation if the s'ibe plan, plat, or the intended use changes. The Improvement Permit shall not be aft�ected by a change in ownership af the site. This permi# is subject to compliance with the provisions of the Laws and Rules for Sewage �reatment and Disposal Systems of the North Carolina Administrative Code. ���� �•�' Authorization To Construct Wastewater Svstem 1Reauired for Buildinq Permitl Wastewater System Description: � nU�H,I lp '- �+�.��ou Wastewater Flow: _� G� a.p.d. Type � C• Facility Description: � � �e s�� �► New ❑ Repair�Expansion 4 Basement? O Yes No Basement �octures? � Yes No �' � Wastewater Svstem Requirements Tankage: Septic Tank size� �D gal. Pump Tank size /� � gal. Grease Trap size �� gal. i'renches: Total length �OD ft. Trench �dth 3 ft. Total Area �a � � sq. ft. Max. Trench Depth: %� in. Aggregate Deoth:�_ in. Soil Cover. 6 in. Trench Separation �R. on center Perrnit Expiration Date: � � � �d � Authorized State Agent Date: S� 3'— �I *See attached site plan and addendum page� for additional permit conditions. , The type of system pennitEed ❑ does ❑ dcaes not differ from the type specified on the application. 1 accept the specffications of this permit ; OwnedLega! Represerrtative Signature: Date: Operation Pertr�it System Type (in accordance with Table Va) _ � This system has heen installed in compliance with applicable �lorth Caroli� t3eneral Statutes, laws and Rules for Sewage Treatment and Disposal, and aU conditions of the Improvemem Permit and Construction Authoraation. Issuance of this permit implies no guara�rtee tfiat the sysbem instaUed will functton prope�iy for arry given period of time. Authorized State Agent Date PCHD, rev. 03/07l01 , �r9q�a C��j �e�lth. �parbne� • � ��'►��a�n�erofad Hesl�h Sec�n � Sii"� SI�T'G�i � 'i'�x��ip � a8 Parcal #� SubdivisioNSec�+oNLn� .��'��fl� _ . . Oa�e � � ' �„� � m�lams �dp. TTllrrs � m�r jla� tba a�e � iArs �t � � tbatpr+�Rrmda �r � , I � ' ?��scoh��.dl� � . ��- --� I � 1_! � l 1�( � I� re- 4w� urE�L 4�cu�,c w� (I nce� p � �,{- .{-a -k+n k at- r� loea�'w�, .�c„n„ �ow..da.��o;+� Q�. `��"�, fQ� r � K 3 �� �� . � �}c�o S �w- �� . . � � �-�C �wG�'- , � ,5 M0.��r^a �i�� �s evtdu-� a''Lct� • � � $' � C'� a�. ..�-a rcc n. � i n e S 1✓� . „ a�` � � � y�.�� n� na � Ze �-Y . � � -�Ti�� ¢''8yn 0 va �/c�lg�.a�� �.- - > ' � �' �dd�-�,'o,.,� � .sai 1 co�er r���.r��� �n o OV2 r ,52/0 }'� G A-Yi° �.. $�• . "'� � � . .— . � .� "— i3c�oc!! r1��k'/ '�J. 0